Risk factors for acute kidney injury in critically ill patients receiving high intravenous doses of colistin methanesulfonate and/or other nephrotoxic antibiotics: a retrospective cohort study

Rocco, Monica; Montini, Luca; Alessandri, Elisa; Venditti, Mario; Laderchi, Amalia; Gennaro, Pascale De; Raponi, Giammarco; Vitale, Michela; Pietropaoli, P; Antonelli, Massimo

doi:10.1186/cc12853

Cited by 81 publications

(68 citation statements)

References 32 publications

(46 reference statements)

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“…The overall incidence of AKI in our study was 16% (35/214), which should be considered low compared to the data of a recent Italian study reporting a 40% incidence of acute renal failure in 279 septic ICU patients (29). This might be explained by our decision to exclude patients with AKI occurring before day 3.…”

Section: Discussioncontrasting

confidence: 48%

Propensity-Based Study of Aminoglycoside Nephrotoxicity in Patients with Severe Sepsis or Septic Shock

Picard

Bazin

Clouzeau

et al. 2014

Antimicrob Agents Chemother

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cTo assess the risk of acute kidney injury (AKI) attributable to aminoglycosides (AGs) in patients with severe sepsis or septic shock, we performed a retrospective cohort study in one medical intensive care unit (ICU) in France. Patients admitted for severe sepsis/septic shock between November 2008 and January 2010 were eligible. A propensity score for AG administration was built using day 1 demographic and clinical characteristics. Patients still on the ICU on day 3 were included. Patients with renal failure before day 3 or endocarditis were excluded. The time window for assessment of renal risk was day 3 to day 15, defined according to the RIFLE (risk, injury, failure, loss, and end-stage renal disease) classification. The AKI risk was assessed by means of a propensity-adjusted Cox proportional hazards regression analysis. Of 317 consecutive patients, 198 received AGs. The SAPS II (simplified acute physiology score II) score and nosocomial origin of infection favored the use of AGs, whereas a preexisting renal insufficiency and the neurological site of infection decreased the propensity for AG treatment. One hundred three patients with renal failure before day 3 were excluded. AGs were given once daily over 2.6 ؎ 1.1 days. AKI occurred in 16.3% of patients in a median time of 6 (interquartile range, 5 to 10) days. After adjustment to the clinical course and exposure to other nephrotoxic agents between day 1 and day 3, a propensity-adjusted Cox proportional hazards regression analysis showed no increased risk of AKI in patients receiving AGs (adjusted relative risk ‫؍‬ 0.75 [0.32 to 1.76]). In conclusion, in critically septic patients presenting without early renal failure, aminoglycoside therapy for less than 3 days was not associated with an increased risk of AKI.A minoglycosides (AGs) have bactericidal activity, which has been proven to be synergic with that of ␤-lactams. Although adding an AG to a standard antibiotic treatment did not translate into a reduction of mortality in Gram-negative-bacterial sepsis in subgroups of patients with globally moderate degrees of severity (1), a decrease in mortality was recently reported in a meta-analysis comparing a bitherapy to therapy with a ␤-lactam alone for patients with septic shock (2). In addition, AGs widen the spectrum of the antibiotic treatment, which should be advantageous in populations with an increased risk of resistant bacteria, such as intensive care unit (ICU) patients (3, 4). Empirical antibiotic treatments including AGs could be more appropriate in up to 15 to 20% of cases than a ␤-lactam alone (5, 6). In the ICU setting, modifications of the empirical antibiotic treatment or the addition of a new antibiotic occurs less frequently after bitherapy including an AG than after monotherapy (7).Unfortunately, nephrotoxicity is an important potential limitation of AGs. There is a consensus that AG-related nephrotoxicity has decreased over the years due to better consideration of both reduced duration of treatment and once-daily administration (8). However...

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Section: Discussioncontrasting

confidence: 48%

Propensity-Based Study of Aminoglycoside Nephrotoxicity in Patients with Severe Sepsis or Septic Shock

Picard

Bazin

Clouzeau

et al. 2014

Antimicrob Agents Chemother

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“…Obez hastalarda nefrotoksisite gelişimi %50 olarak rapor edilmiştir. 8,9 Ancak bu çalışmadaki hastaların kolistin kullanım sü-resi 14 günden az tutulmuştur. 10 Normal kilolu hastalarda ise %15'ten daha az tespit edilmiştir.…”

Section: Discussionunclassified

“…Çalışma sonuçlarına göre, tüm gruplarda %40 oranında nefrotoksisite gelişmiş ve bu durumun kolistin kullanım süresinden çok, septik şok varlığı ve yüksek (>43) SAPS II skoru varlığına bağlı olduğu gösteril-miştir. 9 Bu çalışmanın zayıf noktası, kolistin kullanım süresinin kısa olmasıdır. Bizim sonuçlarımızla karşılaştırıldığında, onlarda olduğu gibi nefrotoksisite gelişen grubumuzun tamamının da inotrop alıyor olması anlamlıdır.…”

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Evaluation of the Use of Colistin on Nephrotoxicity and Mortality in the Intensive Care Unit

Arslan¹,

Özbudak²,

Türkyılmaz³

et al. 2015

Turkiye Klinikleri J Anest Reanim

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Ö ÖZ ZE ET T A Am ma aç ç: : Kolistin, siklik yapılı katyonik polipeptidlerin bir üyesidir. Son yıllarda çoklu ilaç dirençli Pseudomonas aeruginosa ve Acinetobacter baumannii enfeksiyonlarında tek seçenek olan kolistinin nefrotoksik etkisi en önemli dezavantajıdır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Etik kurul onayı alındıktan sonra, Ocak 2012-Aralık 2013 tarihleri arasında yoğun bakım ünitesinde yatan ve çoklu ilaç dirençli gram-negatif enfeksiyon geliş-mesi nedeni ile beş günden daha fazla intravenöz 3-5 mg/kg kolistin kullanmış hastalar bu çalışmaya dâhil edildi. Yatışında böbrek fonksiyon bozukluğu saptanan hastalar çalışma dışı bırakıldı. Hastalar akut böbrek hasarı gelişen ve gelişmeyenler olarak iki gruba ayrıldı. B Bu ul lg gu ul la ar r: : İki yıl süresince, yoğun bakım ünitesinde 48 hastanın beş günden daha fazla kolistin kullandığı ve bu hastalardan beşinin geldiklerinde kronik böbrek yetersizliği olduğu tespit edildi. Kalan 43 hastanın 15 (%35)'inde akut böbrek hasarı geliştiği saptandı. Bu iki grup arasında kabulleri esnasındaki yaş, cinsiyet, APACHE II skorları, sedimentasyon ve C-reaktif protein dü-zeyleri, üreyen patojen ve üreme yerleri, ek nefrotoksik ilaç kullanımı açısından fark saptanmadı. Hastaların hepsinin mekanik ventilatöre bağlı olduğu, kolistin başlama endikasyonunun ise çoklu ilaç dirençli P. aeruginasa ve A. baumannii enfeksiyonuna bağlı ventilatörle ilişkili pnömoni olduğu saptandı. Akut böbrek hasarı gelişen grupta kolistin kullanım süresi uzundu (11,8±7,3 ve 17,7±14,3 gün; p=0,009). Akut böbrek hasarı gelişen grubun yoğun bakım ünitesinde yatış süreleri daha uzun (30±18,1 ve 46,1±29,1; p=0,04) ve mortalite oranı daha yüksekti (%80 vs %36; p=0,006). Akut böbrek hasarı gelişen grubun hepsi inotrop kullanmıştır (p<0,001). S So on nu uç ç: : Kolistin nefrotoksisitesi, kullanım süresi ile ilişkili görünmektedir. Kolistinle indüklenen nefrotoksisite gelişen hastalarda yoğun bakım ünitesinde kalış süresi uzamakta ve mortalite artmaktadır. Bu konuda yapılacak çok-merkezli çalışmalara ihtiyaç vardır.A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Kolistin; ölüm oranı; yoğun bakım; akut böbrek hasarı A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Colistin is the member of the cyclic structured cationic polypeptides. In the recent years, colistin is the only choice for the multidrug resistant Pseudomonas aeruginosa and Acinetobacter baumannii infections but its nephrotoxicity is the most important disadvantage. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : After research ethics committee approval, patients who had stayed in the intensive care unit more than five days and used intravenous colistin 3-5 mg/kg for multiple drug resistant gram-negative infection between January 2012 and December 2013 were enrolled in this retrospective study. Patients who had known renal function disorder before the intensive care unit acceptance were excluded from the analysis of this study. Patients were divided into two groups as; acute kidney injury develop...

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“…Some recent studies have investigated the risk factors for colistin-associated NT (8,21,(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). Results from previous studies are given with their significance levels in Table 5.…”

Section: Discussionmentioning

confidence: 99%

“…Two large studies demonstrated that patients with septic shock had a higher incidence of NT (26)(27)(28)(29).…”

Section: Discussionmentioning

confidence: 99%

Risk factors for colistin-associated nephrotoxicity and mortality in critically ill patients

Özkarakaş¹,

Köse²,

Zincircioğlu³

et al. 2017

Turk J Med Sci

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Background/aim: Colistin is gaining popularity against multidrug-resistant bacteria. The primary concern with colistin is its nephrotoxicity (NT). The aim of this study was to evaluate the incidence and risk factors for NT and to evaluate the risk factors for mortality in the toxicity group.Materials and methods: NT was defined according to the RIFLE criteria. Data of patients who did or did not develop NT were compared. Positive and negative predictive values, risk ratio, and correlation coefficients were calculated.Results: NT was seen in 39 patients (70%). Hypoalbuminemia, old age, and the use of vasopressors (VPs) were associated with NT. The use of VPs had the highest positive predictive value, while age had the highest negative predictive value and risk ratio. The only variable that was associated with mortality in the toxicity group was VP use. Conclusion:Aging, hypoalbuminemia, and the use of VPs were shown to be risk factors for NT, while the last of these was the only significant risk factor for mortality in the toxicity group.

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Risk factors for acute kidney injury in critically ill patients receiving high intravenous doses of colistin methanesulfonate and/or other nephrotoxic antibiotics: a retrospective cohort study

Cited by 81 publications

References 32 publications

Propensity-Based Study of Aminoglycoside Nephrotoxicity in Patients with Severe Sepsis or Septic Shock

Propensity-Based Study of Aminoglycoside Nephrotoxicity in Patients with Severe Sepsis or Septic Shock

Evaluation of the Use of Colistin on Nephrotoxicity and Mortality in the Intensive Care Unit

Risk factors for colistin-associated nephrotoxicity and mortality in critically ill patients

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